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- Title
Selective use of episiotomy: what is the impact on perineal trauma? Results from a retrospective cohort study.
- Authors
Franchi, Massimo; Parissone, Francesca; Lazzari, Cecilia; Garzon, Simone; Laganà, Antonio Simone; Raffaelli, Ricciarda; Cromi, Antonella; Ghezzi, Fabio
- Abstract
<bold>Purpose: </bold>To evaluate the effects of selective use of episiotomy on perineal trauma.<bold>Methods: </bold>We performed a retrospective cohort study on consecutive vaginal deliveries from January 2010 to December 2016. From January 2010 to December 2011 episiotomy was performed liberally, based only on individual midwife/doctor's decision. Since January 2012, a shared selective use of episiotomy policy has been introduced. To evaluate the range of perineal trauma in spontaneous second-degree perineal tears, a sub-classification of second-degree lacerations has been introduced dividing them into two sub-groups: A (smaller than the average episiotomy) and B (spontaneous vaginal tear larger than the average episiotomy). The primary outcomes were the incidence and type of perineal trauma, with the proportion of type A and type B second-degree spontaneous tears under a policy of selective episiotomy.<bold>Results: </bold>Deliveries not exposed to selective use of episiotomy were 1583 (Group 1), those exposed to selective use of episiotomy were 6409 (Group 2). In Group 2 episiotomy rate decreased, and incidence of intact perineum, first- and second-degree lacerations increased. The incidence of third- and fourth-degree lacerations did not change. Spontaneous second-degree lacerations occurred in 19.4% and 36.8% of women in group 1 and 2, respectively. With a selective episiotomy policy, 88.3% of second-degree tears was classified as type A.<bold>Conclusions: </bold>The selective use of episiotomy is clinically feasible and effective. This policy seems to be associated with a lower delivery-related perineal trauma as showed by the sub-classification, that could be a useful tool to monitor obstetric care.
- Subjects
COHORT analysis; EPISIOTOMY; RETROSPECTIVE studies; PERINEUM; LABOR complications (Obstetrics)
- Publication
Archives of Gynecology & Obstetrics, 2020, Vol 301, Issue 2, p427
- ISSN
0932-0067
- Publication type
journal article
- DOI
10.1007/s00404-019-05404-5